Basic (10-09)
The DDS Administrator has the authority and flexibility to design a QA function best suited to the needs of the agency and assigns roles accordingly. For additional information on the guidelines for providing a QA function, see DI 39515.001.
ensures the effectiveness of the internal DDS QA system;
establishes a system for resolving policy-issue differences between the quality assurance unit (QAU) and supervisors;
receives synthesized analyses of data from all QA reviews;
directs the implementation of corrective actions based on QA findings and recommendations, and,
may establish performance standards for QAU staff.
ensures that unit personnel meet DDS quality and processing standards;
reviews work of the unit;
provides feedback to examiners on the timeliness and appropriateness of their actions;
evaluates examiners’ work at various stages of development as part of an in-line quality review approach;
verifies that special workloads such as Presumptive Disability decisions, Quick Disability Determinations, Military Casualty Cases, and Compassionate Allowances are developed and adjudicated correctly;
approves requests for consultative examinations;
confirms compliance with internal referrals and procedures;
ensures adherence to Program Operational Manual System (POMS) adjudicative guidelines;
certifies the accuracy of determinations and decision notices;
reviews quality feedback and individual case returns from the QAU and SSA review components; and,
may assist in the preparation of claims to be submitted for Request for Program Consultation (RPC) referral.
reviews a random sample of cases;
reviews high-risk cases;
undertakes special studies;
records and provides data regarding the quality and characteristics of the cases reviewed;
may assist in the preparation of claims to be submitted for Request for Program Consultation (RPC) referral;
analyzes all available data on DDS performance;
provides recommendations for improvement; and,
may train and mentor staff.
An MC or PC other than the one who completed the assessment on the case should perform the QA review.
reviews QA sample cases with medical issues on behalf of the QAU;
analyzes cases with medical issues returned to DDS by SSA;
reviews special workloads and high risk cases as necessary; and,
may conduct peer reviews.
ensures consideration of the Residual Functional Capacity (RFC) assessment with vocational factors such as age, education, training, and work experience; and,
trains and mentors staff on vocational issues.
keeps up to date on all disability program changes and resources;
prioritizes casework;
considers alternative courses of development;
consults with the supervisor, QA staff, MC/PC, and VS as needed;
records the reasoning to support the decision in the file;
conducts a final review of the file before releasing the decision; and,
may assist in training and mentoring new DEs.